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Meta-Analysis
. 2005 Jul 20;2005(3):CD001439.
doi: 10.1002/14651858.CD001439.pub2.

Antibiotics versus placebo for prevention of postoperative infection after appendicectomy

B R Andersen  1 , F L Kallehave, H K Andersen
Affiliations
Meta-Analysis

Antibiotics versus placebo for prevention of postoperative infection after appendicectomy

B R Andersen et al. Cochrane Database Syst Rev. .

Abstract

Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated. Despite improved asepsis and surgical techniques, postoperative complications, such as wound infection and intraabdominal abscess, still account for a significant morbidity. Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes.

Objectives: This review evaluated the use of antibiotics compared to placebo or no treatment in patients undergoing appendectomy. Will these patients benefit from antimicrobial prophylaxis? The outcomes were described according to the nature of the appendix, as either simple appendicitis (including the non-infectious stage) and complicated appendicitis. The efficacy of different antibiotic regimens were not evaluated.

Search strategy: We searched The Cochrane Central Register of Controlled Trials (Cochrane Library 2005 issue 1); Pubmed ; EMBASE; and the Cochrane Colorectal Cancer Group Specialised Register (April 2005). In addition, we manually searched the reference lists of the primary identified trials.

Selection criteria: We evaluated Randomised Controlled Trials (RCTs) and Controlled Clinical Trials (CCTs) in which any antibiotic regime were compared to placebo in patients suspected of having appendicitis, and undergoing appendectomy. Both studies on children and adults were reviewed. The outcome measures of the studies were: Wound infection, intra abdominal abscess, length of stay in hospital, and mortality.

Data collection and analysis: Eligibility and trial quality were assessed, recorded and cross-checked by two reviewers.

Main results: Forty-five studies including 9576 patients were included in this review. The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess, with no apparent difference in the nature of the removed appendix. Studies exclusively on children and studies examining topical application reported results in favour to the above, although the results were not significant.

Authors' conclusions: Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients, whether the administration is given pre-, peri- or post-operatively, and could be considered for routine in emergency appendectomies.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Systemic Antibiotics vs Placebo (Clinical), Outcome 1 Wound infection.
1.2
1.2. Analysis
Comparison 1 Systemic Antibiotics vs Placebo (Clinical), Outcome 2 Postoperative intra abdominal abscess.
1.3
1.3. Analysis
Comparison 1 Systemic Antibiotics vs Placebo (Clinical), Outcome 3 Length of stay in hospital.
2.1
2.1. Analysis
Comparison 2 Systemic antibiotics vs placebo (Pathoanatomic), Outcome 1 Wound infection.
2.2
2.2. Analysis
Comparison 2 Systemic antibiotics vs placebo (Pathoanatomic), Outcome 2 Postoperative intra abdominal abscess.
3.1
3.1. Analysis
Comparison 3 Topical Antibiotics vs Placebo, Outcome 1 Wound infection.
3.3
3.3. Analysis
Comparison 3 Topical Antibiotics vs Placebo, Outcome 3 Lenght of stay in hospital.
4.1
4.1. Analysis
Comparison 4 Pre‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 1 Wound infection.
4.2
4.2. Analysis
Comparison 4 Pre‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 2 Postoperative intra abdominal abscess.
4.3
4.3. Analysis
Comparison 4 Pre‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 3 Length of stay in hospital.
5.1
5.1. Analysis
Comparison 5 Pre‐operatively administered multiple agent, single dose Antibiotics vs Placebo, Outcome 1 Wound infection.
6.1
6.1. Analysis
Comparison 6 Per‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 1 Wound infection.
6.2
6.2. Analysis
Comparison 6 Per‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 2 Postoperative intra abdominal abscess.
6.3
6.3. Analysis
Comparison 6 Per‐operatively administered single agent, single dose Antibiotics vs Placebo, Outcome 3 Length of stay in hospital.
7.1
7.1. Analysis
Comparison 7 Per‐operatively administered multiple agent, single dose Antibiotics vs Placebo, Outcome 1 Wound infection.
8.1
8.1. Analysis
Comparison 8 Operatively single agent and post‐operatively single agent, single dose Antibiotics vs placebo, Outcome 1 Wound infection.
8.2
8.2. Analysis
Comparison 8 Operatively single agent and post‐operatively single agent, single dose Antibiotics vs placebo, Outcome 2 Postoperative intra abdominal abscess.
9.1
9.1. Analysis
Comparison 9 Operatively single agent and post‐operatively single agent, multiple dose Antibiotic vs Placebo, Outcome 1 Wound infection.
9.2
9.2. Analysis
Comparison 9 Operatively single agent and post‐operatively single agent, multiple dose Antibiotic vs Placebo, Outcome 2 Postoperative intra abdominal abscess.
9.3
9.3. Analysis
Comparison 9 Operatively single agent and post‐operatively single agent, multiple dose Antibiotic vs Placebo, Outcome 3 Length of stay in hospital.
11.1
11.1. Analysis
Comparison 11 Operatively multiple agent and post‐operatively multiple agent, multiple dose Antibiotics vs placebo, Outcome 1 Wound infection.
11.2
11.2. Analysis
Comparison 11 Operatively multiple agent and post‐operatively multiple agent, multiple dose Antibiotics vs placebo, Outcome 2 Postoperative intra abdominal abscess.
11.3
11.3. Analysis
Comparison 11 Operatively multiple agent and post‐operatively multiple agent, multiple dose Antibiotics vs placebo, Outcome 3 Length of stay in hospital.
12.1
12.1. Analysis
Comparison 12 Systemic antibiotics vs Placebo in children, Outcome 1 Wound infection.
12.2
12.2. Analysis
Comparison 12 Systemic antibiotics vs Placebo in children, Outcome 2 Postoperative intra abdominal abscess.
13.1
13.1. Analysis
Comparison 13 Operatively single agent and post‐operatively single agent, multiple dose Antibiotic vs Placebo in children, Outcome 1 Wound infection.
13.2
13.2. Analysis
Comparison 13 Operatively single agent and post‐operatively single agent, multiple dose Antibiotic vs Placebo in children, Outcome 2 Postoperative intra abdominal abscess.
14.1
14.1. Analysis
Comparison 14 Operatively multiple agent and post‐operatively multiple agent, multiple dose Antibiotics vs placebo, children, Outcome 1 Wound infection.
14.2
14.2. Analysis
Comparison 14 Operatively multiple agent and post‐operatively multiple agent, multiple dose Antibiotics vs placebo, children, Outcome 2 Postoperative intra abdominal abscess.
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Update of

References

References to studies included in this review

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Griffiths 1976 {published data only}
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Harnoss 1986 {published data only}
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Hutchinson 1983 {published data only}
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Keiser 1983 {published data only}
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Kekomäki 1983 {published data only}
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Kizilcan 1992 A {published data only}
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Kizilcan 1992 B {published data only}
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Kizilcan 1992 C {published data only}
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Kortelainen 1982 {published data only}
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Leigh 1976 {published data only}
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Morris 1980 A {published data only}
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Morris 1980 B {published data only}
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Paakkonen 1982 {published data only}
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Raahave 1970 {published data only}
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Richards 1981 {published data only}
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Rodgers 1979 {published data only}
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Rowlands 1982 {published data only}
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Saario 1981 {published data only}
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Salo 1981 {published data only}
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Sole 1982 {published data only}
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Stoller 1965 {published data only}
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Söderquist 1995 A {published data only}
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Viitanen 1984 B {published data only}
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Wayand 1982 {published data only}
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Willis 1976 {published data only}
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References to studies excluded from this review

Amgwerd 1981 {published data only}
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Herrera‐Garcia 1985 {published data only}
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Kling 1985 {published data only}
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Leigh 1978 {published data only}
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Marti 1978 {published data only}
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McGreal 2002 {published data only}
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McLean 1983 {published data only}
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Okubadejo 1976 {published data only}
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Pietila 1982 {published data only}
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Pollock 1972 {published data only}
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Rambo 1972 {published data only}
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Tanphiphat 1978 {published data only}
    1. Tanphiphat C, Sangsubhan C, Vongvaravipatr V, La‐Ongthong B, Chodchoy V, Treesaranuvatana S, Ittipong P. Wound infection in emergency appendicectomy: a prospective trial with tropical ampicillin and antiseptic solution irrigation. Br J Surg 1978;65(2):89‐91. - PubMed
Taylor 2000 {published data only}
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Taylor 2004 {published data only}
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Walsh 1981 {published data only}
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Willis 1979 {published data only}
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References to studies awaiting assessment

Simpson 2002 {published data only}
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